In the US, Candida Most Common Culture in Endogenous Endophthalmitis

It is evident that developments in modern medicine have improved survival for patients with this condition; however, it still remains significantly vision-threatening with only 52% of this cohort achieving 20/400 or better vision. Photo: Bluefin Vision. Click image to enlarge.Due to its low incidence and absence of prospective trials, there are no standardized evidence-based treatment guidelines for the treatment of endogenous endophthalmitis. The rarity of endogenous endophthalmitis and heterogeneity of causative organisms make it difficult to formulate universal protocols.Researchers from Bascom Palmer in Miami aimed to help fill this gap by reviewing cases of culture-proven endogenous endophthalmitis at a large tertiary eye center with the goal of better characterizing the spectrum of presentations, management approaches and treatment outcomes to enhance the understanding of this uncommon entity and inform future care. They found that Candida species remained the most common isolate in cases of endogenous endophthalmitis. Their findings, which were published in Journal of Ophthalmic Inflammation and Infection, also highlighted that endogenous endophthalmitis often presents subacutely, without obvious systemic illness, which can lead to misdiagnoses or delayed treatment.“Endogenous endophthalmitis continues to pose a diagnostic and therapeutic challenge,” the study authors wrote in their paper. “It is imperative that physicians maintain a high clinical suspicion for this condition in patients with known risk factors who develop atypical intraocular inflammation.”The researchers conducted a retrospective review of medical records of patients with culture-proven endogenous endophthalmitis between 2013 and 2024. A total of 50 eyes from 41 patients were identified. Of these, 30 of 41 (73%) presented in an outpatient setting. The most common presenting symptom was blurred vision in 36 of 41 (88%), with only 16 of 41 (39%) presenting with systemic symptoms.The most common presenting symptom was blurred vision in 36 of 41 (88%), with only 16 of 41 (39%) presenting with systemic symptoms. Vitreous cultures disclosed fungal organisms in 19 of 41 (46%) of cases and bacterial in the remainder. Blood cultures were positive in 23 of 41 (56%). A systemic source of infection was identified in 23 of 41 (56%), most often associated with indwelling medical devices in seven of 23 (30%). Intravenous drug use was present in seven of 41 (17%). All patients received intravitreal antimicrobials and 25/50 (50%) underwent vitrectomy. Death associated with systemic infection occurred in only three of 41 (7%) of patients. Evisceration was performed in two of 50 (4%) eyes. Visual acuity at the last follow-up was ≥ 20/400 in 26 of 50 (52%) of eyes.In contrast, Klebsiella pneumoniae, which is the leading cause of endogenous endophthalmitis in many Asian series, often associated with hepatic abscesses, only comprised 7% of isolates in the current study. The most common source of infection in the present cohort was related to medical devices such as indwelling catheters, ports or other lines. The researchers noted that identification and treatment of these extraocular foci is important to reduce the occurrence of ongoing septic emboli to the eye and other organs.The team emphasized that diagnostic uncertainty remains a significant issue, particularly for fungal cases. The current study identified 12% of patients who were initially misdiagnosed.“Such diagnostic pitfalls underscore the need for a high index of suspicion, even in patients without classic systemic infection signs,” they wrote in their paper. “It is important that endogenous endophthalmitis is considered in the differential diagnosis of patients with atypical intraocular inflammatory findings and any major risk factors for systemic disease, as delays in appropriate therapy can jeopardize both a patient’s vision and life."Click here for the source. Zhang C, Tadross M, Kang S, et al. Culture-proven endogenous endophthalmitis: ocular and systemic clinical features and outcomes. J Ophthalmic Inflamm Infect. May 25, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.